An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial.

INTRODUCTION: Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information 'Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. METHODS AND ANALYSIS: We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13-18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale-Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. ETHICS AND DISSEMINATION: Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.

Talking 'Bout Better outcomes for Adolescent Depression: Youth and Caregiver Perspectives on an Integrated Care Pathway for Depression.

BACKGROUND: Depression is a common condition among adolescents, with rates continuing to rise. A gap exists between evidence-based recommendations for the treatment of depression and clinical practice. Integrated Care Pathways (ICPs) can help address this gap, but to date no study has examined how young people and their caregivers experience ICPs and whether these pathways are an acceptable form of care. This study used focus groups with adolescents, caregivers, and service providers to examine experiences of an ICP. METHODS: Six individual interviews with service providers, four focus groups with youth, and two focus groups with caregivers were completed. Data was analyzed consistent with Braun & Clarke's Thematic Analysis Framework within an interpretivist paradigm. RESULTS AND CONCLUSION: The study demonstrated that ICPs are acceptable to youth and their caregivers and that ICPs facilitate shared decision making between youth/caregivers and care providers. Findings also indicated that youth are willing to engage with ICPs particularly when there is a trusted clinician involved who helps interpret and tailor the ICP to the young person's experience. Further questions include how to best integrate these into the overall system and how to further tailor these pathways to support youth with diagnostic complexity and treatment resistance.

Understanding Bullying and Cyberbullying Through an Ecological Systems Framework: the Value of Qualitative Interviewing in a Mixed Methods Approach.

Recognized as complex and relational, researchers endorse a systems/social-ecological framework in examining bullying and cyberbullying. According to this framework, bullying and cyberbullying are examined across the nested social contexts in which youth live-encompassing individual features; relationships including family, peers, and educators; and ecological conditions such as digital technology. Qualitative inquiry of bullying and cyberbullying provides a research methodology capable of bringing to the fore salient discourses such as dominant social norms and otherwise invisible nuances such as motivations and dilemmas, which might not be accessed through quantitative studies. Through use of a longitudinal and multi-perspective mixed methods study, the purpose of the current paper is to demonstrate the ways qualitative interviews contextualize quantitative findings and to present novel discussion of how qualitative interviews explain and enrich the quantitative findings. The following thematic areas emerged and are discussed: augmenting quantitative findings through qualitative interviews, contextualizing new or rapidly evolving areas of research, capturing nuances and complexity of perspectives, and providing moments for self-reflection and opportunities for learning.

Developing a model of broaching and bridging in cross-cultural psychotherapy: Toward fostering epistemic and social justice.

Epistemic and social injustice occurs when therapists implicitly and explicitly impose personal, professional, and institutional power onto clients, and dismiss client experience which is embedded in cultural identity and social location. Despite research evidence highlighting the positive impact of broaching in cross-cultural psychotherapy, questioning the rationale and barriers to broaching is paramount. Drawing from scholarship on epistemic in/justice, we argue that the very existence of marginalization of a client in the life and in the therapy exemplifies epistemic injustice. Epistemic injustice bears two types-testimonial and hermeneutic injustice. When clients' experience of marginalization is decentered or discredited, testimonial injustice occurs. By not providing clients with opportunities to share this experience in therapy, there is little shared understanding cultivated in the cross-cultural dyad, contributing to hermeneutic injustice. Thus, epistemic in/justice requires broaching not as an option but as an integral part of therapy. Synthesizing scholarship in cultural competence, humility, intersectionality, and antioppressive practice, we define broaching as the therapist's tasks for intentional understanding of the cultural aspects and systemic oppression in the client's life-in-context. A therapist who is broaching is aware of cross-cultural similarities and differences and the workings of power in the therapy dyad and makes deliberate efforts to demonstrate this understanding to the client which includes explicit discussion in sessions. We propose pathways, dimensions, foci, and timing of ongoing broaching and bridging cross-cultural encounters in therapy. Lastly, we discuss the implications of broaching and bridging while situating this work as promoting epistemic and social justice in therapy encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Microskills of broaching and bridging in cross-cultural psychotherapy: Locating therapy skills in the epistemic domain toward fostering epistemic justice.

Psychotherapy research has shown evidence of positive impacts of broaching cultural differences on the therapy process and outcomes. This increasing body of research also highlights a need to clarify clinical skills of broaching and subsequent bridging to guide therapists in cross-cultural psychotherapy. In articulating microskills to promote broaching and bridging, we critically reflect on cautions against slipping into a technocratic approach that is a mechanical prescriptive skill-based guideline. Using critical theory on epistemic injustice, we examine how to integrate cultural aspects into therapy conversations that are aligned with epistemic and social justice. Drawing from sociolinguistic and critical scholars on language and power, we interrogate epistemic domains of knowledge and power during broaching and bridging in everyday clinical talks. We focus on theorizing and illustrating "how-to-do" broaching and bridging to guide therapists in everyday cross-cultural encounters with selected microskills such as a therapist's self-disclosure, cultural immediacy, and reflective listening. Using case illustrations with detailed transcripts for each skill, we interrogate how a client's epistemic status can be managed in the moment-to-moment conversation between a client and therapist in the continuum from dismissing to deepening the client's experience. A series of detailed case illustrations are intended to guide therapists' self-reflection and/or train therapists toward meaningful cross-cultural work. Lastly, we discuss the implications of broaching and bridging while situating this work as promoting epistemic justice in cross-cultural therapy encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social Work Practice During COVID-19: Client Needs and Boundary Challenges.

While information and communication technologies (ICTs) permeated social work practice long before the onset of COVID-19, the abrupt need to close non-essential workplaces resulted in an unparalleled incorporation of digital technology into practice across the globe. The onset of COVID-19 occurred during phase two of research in which we were investigating social workers' informal use of ICT with clients. Prior to COVID-19, we were conducting interviews with practitioners and clients from four agencies serving diverse client populations in a large city in Canada. With the onset of COVID-19, we adapted to the COVID-19 context and amended the questions to investigate ICT use during the pandemic. In addition, with ethics approval, we conducted second interviews with practitioners interviewed prior to COVID-19 with a revised guide to address the pandemic context; and we continued to recruit and interview practitioners and clients using an amended interview guide incorporating pandemic-related questions. The sample comprised 27 practitioners and 22 clients. Eleven practitioners participated in interviews prior to and during COVID-19. Analysis of transcribed interviews revealed that the COVID-19 context had led to a paradigm shift in practitioners' ICT use, with two key themes identified: (1) boundary challenges and (2) clients' diverging ICT needs. We discuss these themes and present implications for policy and practice in a post-COVID-19 world.

Preparing social workers to address health inequities emerging during the COVID-19 pandemic by building capacity for health policy: a scoping review protocol.

INTRODUCTION: The COVID-19 pandemic has brought tremendous changes in healthcare delivery and exacerbated a wide range of inequities. Social workers across a broad range of healthcare settings bring an expertise in social, behavioural and mental healthcare needed to help address these health inequities. In addition, social workers integrate policy-directed interventions and solutions in clinical practice, which is a needed perspective for recovery from the COVID-19 pandemic. It remains unclear, however, what the most pressing policy issues are that have emerged during the COVID-19 pandemic. In addition, many social workers in health settings tend to underuse policy in their direct practice. The objectives of this scoping review are to: (1) systematically scope the literature on social work, COVID-19 pandemic and policy; and (2) describe the competencies required by social workers and the social work profession to address the policy issues emerging during the COVID-19 pandemic. METHODS AND ANALYSIS: The scoping review follows Arksey and O'Malley's five-stage framework. Identification of literature published between 1 December 2019 and the search date, 31 March 2021, will take place in two stages: (1) title and abstract review, and (2) full-text review. In partnership with a health science librarian, the research team listed keywords related to social work and policy to search databases including Medline, Embase, PsycINFO, CINAHL, Social Services Abstract and Social Work Abstracts. Two graduate-level research assistants will conduct screening and full-text review. Data will then be extracted, charted, analysed and summarised to report on our results and implications on practice, policy and future research. ETHICS AND DISSEMINATION: Results will help develop a policy practice competence framework to inform how social workers can influence policy. We will share our findings through peer-reviewed publications and conference presentations. This study does not require Research Ethics Board approval as it uses publicly available sources of data.

Looking Beyond Assumptions to Understand Relationship Dynamics in Bullying.

To account for the complex relationships and processes that constitute the phenomenon of bullying, it is critical to understand how students and their parents and teachers conceptualize traditional and cyberbullying. Qualitative data were drawn from a mixed methods longitudinal study on cyberbullying. Semi-structured interviews were held with Canadian students in grades 4, 7, and 10 in a large urban school board, and their parents and teachers. To account for the complexity and interactions of different systems of relationships, the purpose of the current article is to examine how students and their matched parents and teachers understand traditional and cyberbullying. Central to participants' understanding of traditional and cyberbullying was whether they considered bullying to represent harmful relationship dynamics. Three main assumptions emerged as shaping participants' understanding of bullying and appeared to obscure the deep relationship processes in bullying: (a) assumptions of gender in bullying, (b) type of bullying-comparing traditional and cyberbullying, and (c) physical bullying as disconnected from relationship dynamics. It is essential that assessment, education, and prevention and intervention strategies in traditional and cyberbullying be informed by the inherent relationships in bullying and be implemented at multiple levels of relationships and broader social systems.

Patient perspectives on quality of care for depression and anxiety in primary health care teams: A qualitative study.

BACKGROUND: Widespread policy reforms in Canada, the United States and elsewhere over the last two decades strengthened team models of primary care by bringing together family physicians and nurse practitioners with a range of mental health and other interdisciplinary providers. Understanding how patients with depression and anxiety experience newer team-based models of care delivery is essential to explore whether the intended impact of these reforms is achieved, identify gaps that remain and provide direction on strengthening the quality of mental health care. OBJECTIVE: The main study objective was to understand patients' perspectives on the quality of care that they received for anxiety and depression in primary care teams. METHODS: This was a qualitative study, informed by constructivist grounded theory. We conducted focus groups and individual interviews with primary care patients about their experiences with mental health care. Focus groups and individual interviews were recorded and transcribed verbatim. Grounded theory guided an inductive analysis of the data. RESULTS: Forty patients participated in the study: 31 participated in one of four focus groups, and nine completed an individual interview. Participants in our study described their experiences with mental health care across four themes: accessibility, technical care, trusting relationships and meeting diverse needs. CONCLUSION: Greater attention by policymakers is needed to strengthen integrated collaborative practices in primary care so that patients have similar access to mental health services across different primary care practices, and smoother continuity of care across sectors. The research team is comprised of individuals with lived experience of mental health who have participated in all aspects of the research process.

Patient- and Family-Centered Care in the Emergency Department for Children With Autism.

BACKGROUND: Emergency department (ED) care processes and environments impose unique challenges for children with autism spectrum disorder (ASD). The implementation of patient- and family-centered care (PFCC) emerges as a priority for optimizing ED care. In this article, as part of a larger study, we explore PFCC in the context of ASD. Our aims were to examine how elements of PFCC were experienced and applied relative to ED care for children with ASD. METHODS: Qualitative interviews were conducted with parents and ED service providers, drawing on a grounded theory approach. Interviews were audio recorded, transcribed verbatim, and analyzed by using established constant comparison methods. Data were reviewed to appraise the reported presence or absence of PFCC components. RESULTS: Fifty-three stakeholders (31 parents of children with ASD and 22 ED service providers) participated in interviews. Results revealed the value of PFCC in autism-based ED care. Helpful attributes of care were a person-centered approach, staff knowledge about ASD, consultation with parents, and a child-focused environment. Conversely, a lack of staff knowledge and/or experience in ASD, inattention to parent expertise, insufficient communication, insufficient family orientation to the ED, an inaccessible environment, insufficient support, a lack of resources, and system rigidities were identified to impede the experience of care. CONCLUSIONS: Findings amplify PFCC as integral to effectively serving children with ASD and their families in the ED. Resources that specifically nurture PFCC emerge as practice and program priorities.

The experiences of physicians, nurses, and social workers providing end-of-life care in a pediatric acute-care hospital.

This qualitative study explored the experiences of social workers, nurses, and physicians providing end-of-life care to children in a pediatric acute-care hospital setting. Findings demonstrated that participants experienced both professional and personal impacts of their work and employed various coping strategies under each of these domains. The acute-care setting was found to create unique challenges in providing end-of-life care. Implications for policy and practice include promotion of both individual and institutional-level coping strategies and supports that meet the various needs of staff. Implications for future research include a nuanced examination of differences in experiences among nurses, social workers, and physicians.

Experiences of adolescents with cancer from diagnosis to post-treatment: a scoping review.

Adolescence is a turbulent time of transition. Facing a serious health issue such as cancer during this time can be challenging and confusing. This study presents a scoping review of 33 research articles including quantitative, qualitative, mixed method, and reviews focused on the experiences of adolescents throughout the cancer journey. Extracted themes across studies identified individual, interpersonal, and environmental aspects of adolescents' experiences in each stage of this trajectory. Implications for these findings are discussed including a need for early diagnosis and treatment of adolescent cancers and developmentally appropriate clinical supports.

Healthcare Providers' Experiences with Autism: A Scoping Review.

Gaps in research knowledge exist regarding patient-provider interactions with individuals with autism in healthcare settings. To address this, a scoping review was conducted focusing on the experiences of healthcare professionals working with individuals with autism. A systematic search and screen of the literature resulted in 27 relevant studies. Six key themes were found across these 27 studies including (1) complexity beyond usual role, (2) limited knowledge and resources, (3) training/prior experience, (4) communication and collaboration, (5) need for information and training, and (6) need for care coordination and systemic changes. The results of this review have implications for future research and practice and should be considered when reflecting on opportunities to enhance research and service provision with individuals with autism.

Cancer survivorship and identity: what about the role of oncology social workers?

With cancer survival rates rapidly increasing over time, more people are living into the survivorship stage of their cancer experience. Furthermore, the experience of cancer may impact individuals long after treatment has ceased. This paper presents the results of a mapping review implemented to explore key themes in the literature related to issues with identity following the completion of cancer treatment. The review included 22 studies including quantitative, qualitative, mixed method, and review studies as well as conceptual papers. Findings revealed key descriptions post-cancer treatment identities, literature focused on dominant discourses and counter-discourses around cancer survivorship, and key themes focused on identity management and the roles of Oncology Social Workers in supporting identity issues in postcancer treatment. This review presents a 'map' of current research on identity and cancer survivorship, helping to identify major gaps in the literature, direct future research, and inform practice.

Working with children with autism and their families: pediatric hospital social worker perceptions of family needs and the role of social work.

Social workers with knowledge of autism can be valuable contributors to client- and family-centered healthcare services. This study utilized a qualitative design to explore pediatric hospital social workers' experiences and perceptions when working with children and youth with autism and their families. Interviews with 14 social workers in a Canadian urban pediatric hospital highlighted perceptions of the needs of families of children with autism in the hospital and challenges and benefits related to the role of social work with these families. Results suggest that pediatric social workers may benefit from opportunities to develop autism-relevant knowledge and skills.

The Experiences of Parents of Pediatric Patients With Acute Lymphoblastic Leukemia, 2 Months After Completion of Treatment.

Diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) can be a highly stressful time for the entire family. While completion of treatment may bring relief to some families, it may also bring about additional anxieties and fear. The primary objective of this article is to present an analysis of the experiences, emotional states, and support needs of parents of pediatric cancer patients 2 months after treatment completion for ALL. Using a qualitative interpretive description approach, transcripts from interviews with 17 parents from the leukemia/lymphoma program of a large urban pediatric cancer center were analyzed using N-Vivo 10 data analysis software. Parents reported simultaneous feelings of relief and apprehension, changing relationships with their health care team and the experience of returning to a life following treatment. Results highlight the need for support for parents on completion of treatment.

The experiences of pediatric social workers providing end-of-life care.

Pediatric social workers working in acute care hospital settings may care for children and their families in end-of-life circumstances. This qualitative study is part of a larger study focusing on the experiences of health care providers working with dying children. This study consisted of 9 semi-structured interviews of acute care pediatric social workers who work with dying children and their families. Themes included the role of social work with dying children, the impact of their work and coping strategies. Authors suggest a hospital-worker partnership in supporting staff and promotion of supportive resources.

Experiences of emergency department care from the perspective of families in which a child has autism spectrum disorder.

Care for children with autism spectrum disorder (ASD) in the emergency department (ED) is increasingly recognized as difficult. Communication, sensory and behavioral challenges in a high intensity environment pose risks for negative experiences and outcomes. Through semi-structured interviews, parents (n = 31) and their children (n = 4) with ASD shared their perspectives on ED care. Participants identified issues that negatively affected care experiences, including care processes, communication issues, insufficient staff knowledge about ASD, and inadequate partnership with parents. Elements contributing to an improved ED experience were also cited, including staff knowledge about ASD, child- and family-centered care, and clarity of communication. Findings inform an emerging model of ED care. Recommendations for capacity building and practice development are offered.

Parent and health care provider perspectives related to disclosure of autism spectrum disorder in pediatric emergency departments.

Children and youth with autism spectrum disorder presenting in emergency departments face potential cognitive, sensory, and behavioral challenges, and it is crucial for providers to be aware of their unique needs. However, disclosure of a child's autism spectrum disorder can be complex for parental caregivers and is not well understood. This qualitative study utilized a grounded theory approach and analyzed data from 28 parents and 16 health care providers related to autism spectrum disorder disclosure within two Canadian pediatric emergency departments. Study results indicated that participants identified benefits and risks of disclosure. Encouraging understanding, expediting service, and preparing health care providers for working with children with autism spectrum disorder were identified as benefits of disclosure. Risks related to disclosure included potential negative attributions toward the children and parental discomfort in disclosing a diagnosis in front of the children. Parents discussed the health care encounters they experienced following disclosure and provided recommendations for improving the disclosure process in the emergency department. It is recommended that future research explore the experiences of parents who choose not to disclose their child's autism spectrum disorder. Greater awareness of the disclosure experience and the development of resources and tools to support communication between parents and health care providers are also recommended.

Toward Practice Advancement in Emergency Care for Children With Autism Spectrum Disorder.

BACKGROUND AND OBJECTIVE: There is increasing recognition that children with autism spectrum disorder (ASD) experience challenges in busy clinical environments such as the emergency department (ED). ASD may heighten adverse responses to sensory input or transitions, which can impose greater difficulty for a child to cope with situational demands. These problems can be amplified in the ED because of its busy and unpredictable nature, wait times, and bodily care. There is little literature documenting ED-based needs of children with ASD to inform clinical guidelines. The objective was to identify stakeholder perspectives in determining clinical priorities and recommendations to guide ED service delivery for children with ASD. METHODS: After qualitative interviews with children, parents, and health care providers conducted in a previous phase of this study, focus groups were convened with parents of children with ASD, ED clinicians, and ED administrators (total n = 60). Qualitative data were analyzed based on an interpretive description approach. RESULTS: Participants identified the ED and its delivery of care as insufficient to meet the unique needs of children with ASD. The following clinical priorities were identified: ASD-focused preparedness for ED procedures and processes, wait time management, proactive strategies for sedation and restraint, child-focused support, health care provider capacity building, post-ED follow-up resources, and transition planning to adult care. Heightened child- and family-centered care were strongly recommended.